N.Y. Medicaid Hospice Program Manual Policy Guidelines, Section I, Eligibility

To be eligible for Medicaid hospice care, the individual’s physician and the hospice

medical director or designee must certify the individual as having a terminal illness with

a life expectancy of fewer than twelve months per benefit period. Individuals must

voluntarily elect to receive hospice care which precludes usage of other Medicare and/or

Medicaid services for the terminal illness and related conditions.

The hospice program is available through Medicaid, Medicare, private payment, and

some health insurers to persons who have a medical prognosis of twelve or fewer

months to live if the terminal illness runs its normal course.

Individuals have the ability to rescind this election and subsequently reapply for hospice

benefits at a later date.

Medicaid recipients who have elected hospice care are to have a recipient

restriction/exception (RR/E) code of C2-HOSPICE-MM placed on their file in eMedNY.

The C2 RR/E code is systematically added to a dual eligible Medicaid recipient’s record

and returned on the ePACES eligibility response when a hospice election period is

received on the Medicare Modernization Act (MMA) file of Dual Eligible Beneficiaries.

The MMA file includes Medicare Parts A, B, C, and D eligibility and enrollment data

including the hospice election date period. For non-dual Medicaid recipients, the C2

RR/E code must be manually entered by submitting a completed Hospice Care Recipient

Restriction/Exception (RR/E) Code Update Form to hospicebilling@health.ny.gov.